T&O - Femoral And Tibial Shaft Fractures And Knee Injuries Flashcards
Femoral and tibial shaft fractures: initial Mx points
- Must resuscitate pt and deal with life threatening injuries first (X match units of blood)
- Assess neurovascular status, especially distal pulses
Femoral and tibial shaft fractures: Rx
-
Intramedullary nail and/or plate and ex-fix
- *Sub trochanteric NOF fractures are not treated with DHS (intertrochanteric are Rx with DHS) and must be treated like a midshaft fracture - with intramedullary nail and screws
- If open fracture: start ABX, take pt to theatres for debridement and washout
Femoral and tibial shaft fractures: specific complications/risks
- Hypovolaemic shock
- Neurovascular: sciatic nerve damage, swelling
- Compartment syndrome
- Respiratory complications: fat embolism, ARDS, pneumonia
Ankle fractures: what rules do you use?
Ottawa ankle rules
Suspect ankle fracture and perform X-ray if:
- Pain in malleolar (lat or med) zone
- Tenderness along distal 6cm of posterior tib/fib including posterior tip of malleoli
- Inability to weight bear both immediately and in ED
Knee injuries: common presentations
-
Swelling:
- Immediate: haemarthrosis = torn cruciates
- Hours later OR overnight (effusion = meniscus or other ligament tear)
-
Pain:
- Meniscal: along joint line, on straightening knee
- vs med/lar margins (collateral ligs)
- Locking: meniscal tear and obstruction
- Giving way: instability following ligament injury
Knee haemarthrosis: causes of primary or secondary bleeding
- Primary:
- Spontaneous bleeding - warfarin, haemophilia
- Secondary:
- Trauma - ACL injury, patella dislocation, meniscal injury, osteophyte fracture
Knee injuries: mechanisms of injury
- Collateral ligaments: torn in valgus or varus strains
- MCL caused by valgus strain on outside of leg
- LCL caused by varus strain
- Twisting injuries: lead to meniscus tears or a rupture of the ACL
- Hyperextension injuries: Ruptured PCL
Knee injuries: unhappy triad
Torn medial meniscus, ACL and MCL
Mx of acutely injured knee
- Full examination of acutely swollen knee is very difficult
- Take X-ray to ensure no fracture
-
If no fracture:
- RICE + later re-examination for pathology
- MRI if meniscal/crucifer injury suspected
Dislocation of patella: MOI and Mx
MOI: blow to side of knee causes lateral dislocation of patella
Mx of 1st time traumatic dislocation is conservative unless there is osteochondral fracture or medial patellar stabilisers
- Reduce patella and put in POP for 3 weeks
- Short cast time with early mobilisation with or without brace and with physio
Fractures of patella: name different ways in which the patella can fracture
- Communited: direct blow, likely to also have damage in underlying femoral condyles - try to reduce and fix, avoid taking patella out
- Transverse fracture of patella: violent contracture of quads against resistance - usually town in two horizontally - open reduction and early mobilisation
Name a few inflammatory conditions affecting the knee
- Cysts of menisci: usually arises from lateral meniscus, enlarges under capsule, forms a swelling which is tense in certain positions of flexion. Is liable to tear, in which removal of meniscus is better than cyst removal.
- Other causes: OA/RA, ankylosis spondylitis, gout
Bursitis in the knees: what are the bursae that can become inflamed in the knee?
Infrapatellar bursitis - Clergyman’s
Suprapatellar Bursitis
Pre-patellar bursitis - Housemaid’s
Bursitis in knees: Mx and Rx
Septic bursitis
- Admit pt if systemically unwell, is immunocompromised, severe infection in surrounding tissue or has other comorbidities such as RA and diabetes.
- Will probably need IV ABX
Primary care Mx of bursitis
- RICE and modify activities which worsen symptoms -Compression
- Analgesia: paracetamol/NSAIDs
- Can aspirate fluid if uncomplicated septic bursitis is suspected OR there is very big swelling
Degenerative conditions knee: popliteal cysts
Popliteal cysts: common all ages, painless swellings in popliteal fossa, often fluctuate in size
- Only excise if cause other symptoms
- Larger/diffuse cysts associated with pathology of knee joint (RA esp)
- Should address/look at underlying cause, can do synovectomy/dissection of cyst